Friday, February 4, 2011

Pro Carb or Low Carb?

I must say, the debate is on!  I am not an extremist, as I believe in moderation but a popular topic in the field of diabetes, especially diabetes and weight loss is, as the title depicts, should we eat high carb, low fat, or low carb, high protein, mod fat.  What should we eat?

I am reading a book at the moment called Living Low Carb, great book!  The author Jonny Bowden compares all the low carb diets on the market. His writing style is witty, fun, and makes complicated biochemistry seem interesting, seriously, definitely worth a read! 

The author uses an analogy to clearly display how silly the current stance is for most health care providers, dietitians and associations that place huge emphasis on how carbs are absolutely essential for a healthy diet.

I love Mr Bowden's illustration:

He talks about a time he was lecturing to a large group.  He tells the group that he going to divide them in half. He explains that they are going to be stranded on a deserted island. The first half will be given only carbohydrate to survive on, and the second half will be given protein and fat but zero carbohydrate.  Then, he asks the audience who will be alive in 12 months.

The answer, backed by research  according to his literature review,  is the group that consumed protein and fat . This claim begs the question; are we being told to consume so much bloody carbohydrate when it's not essential for our survival. So I did my own lit search, not a google search but an actual lit search.

I do believe Mr Bowden and the Low Carb crew may be onto something.

The first study article written by Dyson, P and colleagues  in Diabetic Medicine took 13 Type 2 diabetics and 13 non-diabetic subjects. They were randomly placed on a low carb diet (less then 40 gms per day) or the usual diet recommended by the UK diabetes association.  They were assessed monthly for three months.  Guess what the results were?  Those assigned to the low carb eating plan, lost more weight but had minimal changes to lipids and A1C levels.  "The diet was equally effective in those with and without diabetes.
So onto the next study"  Okay good info, interesting.....

Another study done by Shai, Iris R.D and colleagues in the New England Journal of Medicine compared weight loss with three mainstream diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. What did they find?

When they randomly assigned 322 moderately obese subjects to one of the three group they concluded that:
"Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions."

Clear as mud right, so what they are telling us is that a lower Carb higher healthy fat diet may be a good alternative compared to the 60-75 % high carb diets normally recommended to us battling the big D. 
Okay, moving on......

The last study authored by  Brinkworth and colleagues in Diabetologia  randomly assigned 66 obese subjects to either a low carb (40 % carb/30% protein)or high carb(55% carb/15% protein) diet.  The results were "A high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with Type 2 diabetes."

So you can loose weight, increase the good fat HDL, with no apparent adverse effect?  Sounds good!

After reading the books, doing a bit of a lit review(not an exhaustive one).  I try to remain unbiased, but the evidence is mounting in favour of a reduced carbohydrate way of eating.  I know that the more carb I consume, the more insulin I need, the hungrier I am, the bigger my waist gets and most importantly the sugars are way harder to control. 

Are you pro carb or low carb or somewhere in between?


Dyson, P. A.; Beatty, S.; Matthews, D. R.(2007). A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects, Diabetic Medicine. 24(12):1430-1435.

Shai, Iris R.D et al.(2008).  Weight Loss with a Low Carbohydrate, Mediterranean, or Low-Fat Diet,

Brinkworth, G. D. 1; Noakes, M. 1; Parker, B. 1; Foster, P. 1; Clifton, P. M. (2004).
Long-term effects o advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial, Diabetologia. 47(10):1677-1686.
New England Journal of Medicine. 359(3):229-241.


Gerry S. said...

Hey Trev, thanks for adding me to your blog list. I also look forward to keeping up with you and 5 kids, wow how do you manage it??
Take care..

Reyna said...

I don't restrict Joe's carbs per-se. I do try to keep him eating about the same amount of carbs at the same time of eliminate that variance in managing "D". I do try to stick with less processed foods...but I am not a "freak" about it.

For myself, I think I tend to eat lower carb than most. Under 80g/day...I don't do it on purpose. I eat a lot of veggies, cheese, and some fruit...and popcorn for snacks.

Great post!

Jonah said...

I'm sorry, pro-carber here.

Here's why: If you're a type 2 diabetic, or have LADA, your body is still making insulin in response to your eating, and is probably doing a good job with your basal insulin needs, but can't keep up with the large dumps of sugar if you eat a high carb meal.
But it can keep up just fine if your proteins very slowly turn to carbs- unstable basal insulin needs don't matter if your body does the figuring out.

Since, if you are eating high protein and low carb, your body will turn amino acids into sugars, this will result in a release of sugars sometimes many hours after you've eaten protein, of an unstable and unpredictable number of sugars. As a type 1 diabetic, I find that impossible to manage.

Also, the diet that keeps you alive the best in the very short term may very well not be the best to keep you alive long term. Somebody with a BMI of 40 has better odds than somebody with a BMI of 20 in terms of being alive next year.
Eating a high fat diet- which most type 1s and type 2s do- is probably more likely to clog arteries, and type 1 and type 2 diabetics are demonstrably more likely to develop heart disease.

At a personal level, I have digestive diseases that make sugar about the easiest thing for me to eat. When I have tried eating lower carb, I eat less, I have more pain, and my basal need for insulin becomes unmanagable.
When I eat high carb, I have much more predictable blood sugars and I eat more.

Since I REALLY don't need to lose weight, and I find that eating an equivalent amount of calories in carbs makes me feel better and gives me more manageable blood sugar, my personal choice of foods is clear.

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Anonymous said...

Pro carber here: But we were dealing with a child dx'd at 8, stick thin; now 14 and still very slender. We try to balance her meals with healthy carbs, protein and try not to go above 20 to 30 percent fat per day. Blood sugars respond differently to same meals a lot, and we know there are many other factors that cause high blood sugars other than food; in children they fluctuate more... at least that's what I am hoping. She does choose what and how much to eat and her carbs per day can now vary from 75 grams to 150 grams. During growth periods, she was eating 220 grams a day. I find exercise is the one factor that leads to good control of blood sugars; I do not need to lower her carbs to achieve this. Low glycemic and mixed balance of carbs are very important; we don't give fruit alone, etc. She is limiting the amount of food she wants to eat and I do not force her to eat more. Seems like she is choosing moderate carb all on her own. However, I am not against low carb for an adult and I do seek low carb recipes so I can have more flexibility in the carbs she does eat. P.S. We were instructed to keep carb load at 60 to 80 grams per meal and we do do this.